Medicare: Massive fraud nets doctor 20-year sentence

Medicare fraud earned Florida doctor $1.2 million – and prison. Sentence is second-stiffest handed out for Medicare fraud in South Florida.

ByJay Weaver, McClatchy NewspapersJune 27, 2011

A closed American Therapeutic Corp. office in Fort Lauderdale, Fla. is shown Oct. 21, 2010, after federal authorities charged the company with Medicare fraud. Federal officials won another victory in South Florida June 27, 2011, when a District judge sentenced a doctor to 20 years for a nearly $20 million Medicare fraud.

MIAMI – A Florida doctor convicted of pocketing more than $1 million for writing phony prescriptions for unnecessary HIV treatments was sentenced Monday to almost 20 years in prison, for his key role in a massive Medicare fraud conspiracy. The scam bilked millions of dollars from the federal health care program.

Dr. Rene de los Rios, a 72-year-old Cuban-born physician trained in Spain, said virtually nothing at his sentencing as U.S. District Judge Joan Lenard hammered him for violating his medical oath, stealing from the vulnerable government program and disgracing himself, his family and his community. She also accused him of "blatantly lying" as a witness during his trial that ended with a jury's guilty verdict in April.

"Dr. de los Rios does not deserve the title of doctor anymore," the judge declared, rejecting his bid for about seven years in prison.

The doctor's sentence was the second stiffest of any meted out against a physician convicted of Medicarefraud in South Florida, which is widely regarded as the capital of crime against the federal program for the elderly and disabled. It rivaled that of Dr. Ana Alvarez-Jacinto, a Miami-Dade County physician convicted of a crime similar to Rios' HIV scam; she was sentenced to 30 years by Chief U.S. District Judge Federico Moreno in 2008.

Alvarez-Jacinto's punishment was upheld last year in an Atlanta-based federal appellate court ruling written by retired U.S. Supreme Court Justice Sandra Day O'Connor. Sitting as a guest panelist, she declared that "a doctor should be punished more severely than other participants because the doctor is breaching a position of trust and an ethical obligation to put the patient's interest first."

Lenard echoed that belief repeatedly Monday as she slammed de los Rios for falsifying hundreds of patient records to justify writing bogus prescriptions for two Miami-Dade clinics — Metro Med of Hialeah and J&F Community Medical Center — that billed Medicare a total of $46.2 million for HIV therapy between 2003 and 2005.

In turn, Medicare paid the clinics $19.7 million for HIV treatments that were either unnecessary or not provided to patients, many of whom received kickbacks for use of their government-issued health care cards.

"It is the medical doctor who holds the position of trust," the judge said. "It was violated by the medical director of Metro Med and J&F."

She reminded de los Rios that while he is 72, he was 64 when he joined the racket headed by Metro Med's owner, Damaris Oliva, who pleaded guilty, cooperated with authorities and was sentenced to about seven years.

According to prosecutors, Oliva learned the Medicare fraud business from brothers Carlos, Luis and Jose Benitez, who owned 11 HIV clinics in Miami-Dade that billed the federal program $119 million and were paid $84 million. They fled to the Dominican Republic and then to Cuba before their indictment was unsealed in 2008. They are believed to be incarcerated in a Cuban jail on immigration violations, according to the FBI.

During the past decade, elaborate HIV schemes cost Medicare billions of dollars, according to the U.S. Department of Health and Human Services' inspector general. HIV clinics throughout South Florida — which had 8 percent of the nation's population with the virus that causes AIDS — were responsible for 72 percent of all claims for HIV infusion drugs in 2005, according to an inspector general's report.

That year, South Florida clinics — mostly concentrated in Miami-Dade — submitted $2.2 billion in HIV-drug infusion bills to Medicare for HIV drugs, according to the study. That was 22 times more than the total HIV claims submitted to Medicare by health care clinics in the rest of the country combined.

On Monday, the judge cited those statistics to dramatize her personal outrage over de los Rios' misconduct. "He signed off and participated in a fraud of huge proportions," Lenard said.

The physician's attorney, Jose Quinon, tried in vain to persuade the judge to lower the sentence to about seven years, arguing that it should be at least comparable to the prison term for Oliva. Quinon also argued that his client was ailing, with a heart condition and diabetes.

"The major issue is whether Dr. de los Rios will be able to die at home or die in some prison," Quinon told the judge. "That is what this is really about."

But Justice Department trial attorney Joseph Beemsterboer countered that the physician deserved no sympathy, arguing for 30 years in prison. He focused on the very issue that troubled the judge the most: de los Rios had been in the medical profession for decades without incident when he decided to become a criminal.

"At that point, he should have known better," Beemsterboer said, adding that authorities still have not been able to recover the $1.2 million the physician received from the clinics. "We still haven't found a dime of that money."